[in Japanese]

View full abstract

This report documents the findings related to language reorganization and memory function learned from the Wada test results of 164 epileptic patients. Four patterns of bilateral language representation were found in 25 patients (15%): Bilateral symmetrical autonomous in 2, bilateral asymmetrical autonomous in 15, bilateral symmetrical dependent in 2, and bilateral asymmetrical dependent (BAD) in 6. In patients with BAD, a shift of the perceptive language function to the opposite-side of the temporal lobe focus, was observed. These results suggested the likelihood that an early age of epilepsy onset in childhood affects language acquisition and a functional shift of the focal language function area because of brain plasticity in response to the adverse effects of epilepsy via the neural network. These findings also suggest that not only the age at the onset of epilepsy but also such factors that determine an originally left-handed person, a patient with a left-sided epileptic focus, or a female gender, may be important factors that have an effect on the language reorganization of the brain. Verbal memory dominance may depend on the language dominant hemisphere.

View full abstract

The aims of this survey were to ascertain differences in the recognition of clinical manifestations related to quality of life (QOL) in patients with epilepsy between the patients/their families and attending physicians and to apply the results to future management of epilepsy. We mailed questionnaires to 5,122 epilepsy patients/their families, all of whom are members of the Japanese Epilepsy Association, and collected them from 1,701 patient/family member respondents and 502 attending physicians. The recognition differences in 427 pairs, matching a patient/family member with an attending physician, were examined. The results revealed that patients and their families put more importance on reducing seizure severity than on reducing seizure frequency in terms of drug therapy goals, and that they are more troubled by seizure-related symptoms, adverse events due to antiepileptic drugs, etc. than their physicians expected. As bridging the gap in recognition between patients/their families and physicians can lead to QOL improvements, a support scheme for patients will need to be established in order to facilitate communication during the limited hours of medical institutions. To be precise, physicians should encourage their patients to keep seizure notebooks and discuss their concerns, using the notebook, each time they visit the out-patient clinic.

View full abstract

We conducted a single-blind, controlled comparative study to assess the effects of lamotrigine (LTG) and zonisamide (ZNS) in the treatment of refractory epilepsy in children. Either LTG or ZNS was added to a concurrent antiepileptic regimen for 12 weeks. Efficacy and usefulness were analyzed in 168 patients and safety was analyzed in 169. As the primary end points of over-all improvement LTG showed non-inferiority effect to ZNS in improvement rate and its distribution. In the Over-50% seizure reduction rate of Lennox-Gastaut syndrome, LTG was significantly superior to ZNS (39% to 13%, p=0.0219). The incidence of adverse events was 43% in LTG group and 54% in ZNS group, and the most common side effect was somnolence in both groups. Two patents in LTG group experienced serious adverse events suspected causal relationship with trial drugs. One was Stevens-Johnson syndrome and another was exacerbation of seizures. There was no significant difference in the safety rate between groups. LTG was significantly superior to ZNS in the global usefulness scale (p=0.0287). These results indicate the significance of LTG in the treatment of intractable childhood epilepsy including LGS.

View full abstract

We report a patient with right temporal lobe epilepsy in whom two kinds of seizure-related psychotic episodes developed. A 36-year-old right-handed woman suffered several complex partial seizures per week that were preceded by auras consisting of fear and deja vu. Despite treatments with various antiepileptic drugs (AEDs), seizures remained intractable. At age 34 years, the AEDs discontinued for a presurgical examination, the habitual seizures increase, and the patient experienced two psychotic episodes within 1 month (Episode I and Episode II). Episode I consisted of abnormal auditory and visual perception and continuous fear with ictal discharge and was diagnosed as aggravated psychiatric aura including 'aura continua'. Episode II consisted of abnormal perception of time and fear and anxiety following a lucid interval. It was diagnosed as postictal psychosis. Although there were definite differences between the two conditions with respect to the clinical course and electroencephalographic findings, we found some common symptoms such as abnormal perception originating in the temporal-occipital region, fear and anxiety, and a dreamy state. These findings suggest that the symptoms of the psychiatric aura and postictal psychosis originated in a shared brain region.

View full abstract

Drug induced hypersensitivity syndrome (DIHS) is one of severe adverse reactions of some aromatic antiepileptic drugs (AEDs). High rate of cross-reactivity among these drugs is an obstacle to select alternative AEDs. We report a 1-year-old boy with DIHS due to phenobarbital (PB) followed by complicated adverse effects of multiple alternatives. He had been receiving sodium valproate (VPA) after his epilepsy had developed at 3 months of age, and PB was added at the age of 1 year 2 months because of seizure relapse. 4 weeks later, he had pyrexia, systemic erythematous rash and thrombocytopenia. Serological examinations revealed the reactivation of human herpes virus 6, and the diagnosis of DIHS was made. The above symptoms improved after cessation of PB and VPA, and administration of prednisolone. However DIHS recurred by ZNS, which was administered instead of PB and VPA. Hence VPA was started again to withdraw ZNS, but that induced severe immune thrombocytopenia (IT). VPA is one of the recommended alternatives after DIHS, however it seems that the state of immune-hyperfunction associated with DIHS accelerated VPA-induced IT. We should pay attention to the administration of alternative AEDs including VPA in DIHS patients.

View full abstract